<script type="text/javascript" src="modules/POBBooking/pnjavascript/validatecapchaform.js"></script>

<style type="text/css">
<!--
.style5 {font-size: medium; font-weight: bold; }
.style6 {color: #FF0000}
-->
</style>

<form id='form' class='form' action="<!--[pnmodurl modname='POBBooking' type='userform' func='submit' ctrl='Customer']-->" method="post" >

      <input type="hidden" name="forward[modname]" value="POBBooking" />
      <input type="hidden" name="forward[type]" value="user" />
      <input type="hidden" name="forward[func]" value="page" />
      <input type="hidden" name="forward[ctrl]" value="redirect" />

      <input type="hidden" name="form[url]" value="<!--[$smarty.post.current.url]-->">
      <input type="hidden" name="form[isocurrency]" value="THB">
      <input type="hidden" name="form[identificational]" value="<!--[$smarty.post.guset.identificational]-->">
      <input type="hidden" name="form[nameprefix]" value="<!--[$smarty.post.guset.titlename]-->">
      <input type="hidden" name="form[givenname]" value="<!--[$smarty.post.guset.firstname]-->">
      <input type="hidden" name="form[surname]" value="<!--[$smarty.post.guset.lastname]-->">
      <input type="hidden" name="form[addressline]" value="<!--[$smarty.post.guset.address]-->">
      <input type="hidden" name="form[cityname]" value="<!--[$smarty.post.guset.city]-->">
      <input type="hidden" name="form[stateprov]" value="<!--[$smarty.post.guset.province]-->">
      <input type="hidden" name="form[countryname]" value="<!--[$smarty.post.guset.country]-->">
      <input type="hidden" name="form[postalcode]" value="<!--[$smarty.post.guset.zipcode]-->">
      <input type="hidden" name="form[mobile]" value="<!--[$smarty.post.guset.mobile]-->">
      <input type="hidden" name="form[phone]" value="<!--[$smarty.post.guset.phone]-->">
      <input type="hidden" name="form[email]" value="<!--[$smarty.post.guset.email]-->">
      <input type="hidden" name="form[addition_request]" value="<!--[$smarty.post.guset.addition_request]-->">
      <input type="hidden" name="form[profiletype]" value="1">
      <input type="hidden" name="form[total_price]" value="<!--[$_POST.booking.totalall]-->">

      <input type="hidden" name="form[cardcode]" value="<!--[$smarty.post.guset.cardtype]-->">
      <input type="hidden" name="form[cardnumber]" value="<!--[$smarty.post.guset.card1]--><!--[$smarty.post.guset.card2]--><!--[$smarty.post.guset.card3]--><!--[$smarty.post.guset.card4]-->">
      <input type="hidden" name="form[cardid]" value="<!--[$smarty.post.guset.cardid]-->">
      <input type="hidden" name="form[cardholdername]" value="<!--[$smarty.post.guset.card_holder_number]-->">
      <input type="hidden" name="form[card_exp_month]" value="<!--[$smarty.post.guset.card_expire_month]-->">
      <input type="hidden" name="form[card_exp_year]" value="<!--[$smarty.post.guset.card_expire_year]-->">
      <input type="hidden" name="form[cardsecurecode]" value="<!--[$smarty.post.guset.cardid]-->">
      <input type="hidden" name="form[cardbankname]" value="<!--[$smarty.post.guset.card_bank_name]-->">
      <input type="hidden" name="form[cardissuingcountry]" value="<!--[$smarty.post.guset.card_issuing_country]-->">
      
      <input type="hidden" name="form[chaincode]" value="<!--[$smarty.post.booking.chaincode]-->">
      <input type="hidden" name="form[hotelcode]" value="<!--[$smarty.post.booking.hotelcode]-->">
      <input type="hidden" name="form[hotelname]" value="<!--[$smarty.post.booking.hotelname]-->">
      <!--[foreach from=$smarty.post.booking.availabilities item=item name="foo"]-->
        <input type="hidden" name="form[availabilities][<!--[$smarty.foreach.foo.index]-->][invcode]" value="<!--[$item.invcode]-->">
        <input type="hidden" name="form[availabilities][<!--[$smarty.foreach.foo.index]-->][date]" value="<!--[$item.date]-->">
        <input type="hidden" name="form[availabilities][<!--[$smarty.foreach.foo.index]-->][rate]" value="<!--[$item.rate]-->">
      <!--[/foreach]-->


<div align="center" style="padding: 2px; background-color: rgb(253, 253, 253); border: 1px dashed rgb(192, 192, 192);">

  <TABLE  width="100%">
    <TR>
      <TH align="left" colspan="2" style="border-bottom: 1px solid rgb(192, 192, 192);"><!--[pnml name="_POBBOOKING_USER_PAYMENT_SUMMARY_CONFIRMATION"]--> </TH>
    </TR>
    <TR>
      <TD width="50%" valign="top" align="right">
        <table width="99%" style="border: 1px dashed rgb(0, 245, 255);">
          <tr>
            <td colspan="3" bgcolor="#DCF5FA"><h6><!--[pnml name="_POBBOOKING_USER_PAYMENT_HOTEL"]-->&nbsp;<!--[$smarty.post.booking.hotelname]-->      &nbsp;</h6></td>
          </tr>
          <!--[foreach from=$smarty.post.booking.roomstays item=item name="foo"]-->
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][invcode]" value="<!--[$item.invcode]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][rate]" value="<!--[$item.rate]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][numberofunits]" value="<!--[$item.numberofunit]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][startdate]" value="<!--[$item.startdate]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][enddate]" value="<!--[$item.enddate]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][adult]" value="<!--[$item.adult]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][child]" value="<!--[$item.child]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][night]" value="<!--[$item.night]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][room_rate_total]" value="<!--[$item.room_rate_total]-->">
              <input type="hidden" name="form[roomstays][<!--[$smarty.foreach.foo.index]-->][guests]" value="2">
          <tr>
            <td width="80"><!--[pnml name="_POBBOOKING_USER_PAYMENT_ROOM_TYPE"]--></td>
            <td><!--[$item.invcode]--></td>
            <td align="right">&nbsp;<!--[math equation="x/y" x=$item.rate y=$item.night assign="oneroomrate"]--><!--[$oneroomrate|number_format:2:".":","]--> <!--[pnml name="_POBBOOKING_USER_PAYMENT_BAHT"]--></td>
          </tr>
          <tr>
            <td width="80"></td>
            <td><!--[$item.numberofunit]-->&nbsp;<!--[pnml name="_POBBOOKING_USER_PAYMENT_ROOM"]-->,<!--[$item.night]-->&nbsp;<!--[pnml name="_POBBOOKING_USER_NIGHT"]--></td>
            <td align="right"><!--[pnml name="_POBBOOKING_USER_PAYMENT_ROOM_PRICE_TOTAL"]-->&nbsp;<!--[math equation="x*y" x=$item.rate y=$item.numberofunit assign="rooms_rate_total"]--><!--[$rooms_rate_total|number_format:2:".":","]--> <!--[pnml name="_POBBOOKING_USER_PAYMENT_BAHT"]--></td>
          </tr>
          <tr>
            <td width="80"><!--[pnml name="_POBBOOKING_USER_PAYMENT_CHECKIN"]--></td>
            <td colspan="2"><!--[$item.startdate]-->&nbsp;</td>
          </tr>
          <tr>
            <td width="80"><!--[pnml name="_POBBOOKING_USER_PAYMENT_CHECKOUT"]-->&nbsp;</td>
            <td colspan="2"><!--[$item.enddate]-->&nbsp;</td>
          </tr>
           <tr>
            <td align="center" colspan="3">--------------------</td>
          </tr>
          <!--[/foreach]-->
        </table>
     </TD>
     <TD width="50%" valign="top" align="left">
        <table width="99%" style="border: 1px dashed rgb(0, 245, 255);">
          <tr>
            <td colspan="2" bgcolor="#DCF5FA"><h6><!--[pnml name="_POBBOOKING_USER_PAYMENT_CUSTOMER"]--></h6></td>
            </tr>
          <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_PAYMENT_FIRST_NAME"]--></td>
            <td><!--[$smarty.post.guset.titlename]--><!--[$smarty.post.guset.firstname]-->&nbsp;</td>
          </tr>
          <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_PAYMENT_LAST_NAME"]--></td>
            <td><!--[$_POST.guset.lastname]-->&nbsp;</td>
          </tr>
          <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_CONTACT_ADDRESS"]-->&nbsp;</td>
            <td><!--[$smarty.post.guset.city]-->,&nbsp;<!--[$smarty.post.guset.province]-->,&nbsp;<!--[$smarty.post.guset.country]--></td>
          </tr>
          <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_CONTACT_TEL"]--></td>
            <td><!--[$_POST.guset.phone]-->&nbsp;</td>
          </tr>
          <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_CONTACT_MOBILE"]-->&nbsp;</td>
            <td><!--[$_POST.guset.mobile]-->&nbsp;</td>
          </tr>
          <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_CONTACT_EMAIL"]-->&nbsp;</td>
            <td><!--[$_POST.guset.email]-->&nbsp;</td>
          </tr>
		      <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_PAYMENT_CREDITCARD"]-->&nbsp;</td>
            <td>xxxx-xxxx-xxxx-<!--[$_POST.guset.card4]-->&nbsp;</td>
          </tr>
		      <tr>
            <td width="100"><!--[pnml name="_POBBOOKING_USER_PAYMENT_ISSUE_DATE"]-->&nbsp;</td>
            <td><!--[$smarty.now|date_format]-->&nbsp;</td>
          </tr>
        </table>
      </TD>
      </TR>
      <TR>
    <TD colspan="2">
        <div style="padding-top: 15px; padding-bottom: 2px;" align="center">
          <table align="center" width="50%" >
                <tr>
                  <td width="50%" align="left"><!--[pnml name="_POBBOOKING_USER_PAYMENT_ROOM_NET_PRICE"]-->              </td>
                  <td align="right"><!--[math equation="x-(x*y)" x=$_POST.booking.totalall y=0.07 assign="net"]--><!--[$net|number_format:2:".":","]-->&nbsp;<!--[pnml name="_POBBOOKING_USER_PAYMENT_BAHT"]--></td>
                </tr>
                <tr>
                  <td width="50%" align="left"><!--[pnml name="_POBBOOKING_USER_PAYMENT_ROOM_INTEREST"]-->
                  </td>
                  <td align="right"><!--[math equation="x*y" x=$_POST.booking.totalall y=0.07 assign="interest"]--><!--[$interest|number_format:2:".":","]-->&nbsp;<!--[pnml name="_POBBOOKING_USER_PAYMENT_BAHT"]--></td>
                </tr>
                <tr>
                  <td align="left"><font size="3" color="#FF3300"><b>
                    <!--[pnml name="_POBBOOKING_USER_TOTAL_PRICE"]-->
                  </b></font></td>
                  <td align="right"><font size="3" color="#FF3300"><b><!--[$_POST.booking.totalall|number_format:2:".":","]-->&nbsp; <!--[pnml name="_POBBOOKING_USER_PAYMENT_BAHT"]--></b></font></td>
                </tr>
          </table>
          <BR>

            <TABLE>
              <TR>
                <TD><!--[gencaptcha]--></TD>
                <TD><input type="text" size="4" name="form[captcha]" id="captcha" />
                        <!--[if not empty($_ERROR)]-->
                          &nbsp;<FONT  COLOR="#F00"><!--[$_ERROR]--></FONT>
                        <!--[/if]--></TD>
              </TR>
            </TABLE>

            <input name="bbSubmit" id="bbSubmit" class="searchButton" style="font-weight: bold; font-size: 11pt; width: 210px; cursor: pointer; color: rgb(0, 0, 0); font-family: tahama; height: 32px;" value="Confirm Your Reservation" type="submit">
            </div>
          <div style="padding-top: 3px; font-family: Arial,Helvetica,sans-serif; font-size: 12px;" align="center">
             <!--[pnml name="_POBBOOKING_USER_PROCESS_BOOKING_BUTTON_1"]--> <i>"<b><!--[pnml name="_POBBOOKING_USER_PROCESS_BOOKING_BUTTON_2"]--></b>"</i> <!--[pnml name="_POBBOOKING_USER_PROCESS_BOOKING_BUTTON_3"]-->
              <p><img src="booking_form.php_files/line.gif" height="1"></p>
              <p>
                <a href="http://phuketcity.com/" target="_blank">www.phuketcity.com</a> <BR>
                  <!--[pnml name="_POBBOOKING_USER_CUSTOMER_CENTER"]--></b>&nbsp; 
                  Tel. +66x xxx xxxx &nbsp; 
                  Fax. +66x xxx xxxx&nbsp; 
                Email : <a href="mailto:info@phuketcity.com">info@phuketcity.com</a> 
              </p>
          </div>
      </TD>
    </TR>
  </TABLE>
  </form>
</div>